Clin Endosc.  2011 Dec;44(2):137-139. 10.5946/ce.2011.44.2.137.

Rifampin-induced Pseudomembranous Colitis with Rectosigmoid Sparing

• Yim SY
• Koo JS
• Kim YJ
• Park SJ
• Kim JN
• Jung SW
• Yim HJ
• Lee SW
• Choi JH
• Kim CD

• KMID: 1805262
• DOI: http://doi.org/10.5946/ce.2011.44.2.137

Abstract

Pseudomembranous colitis (PMC) is known to be associated with antibiotic treatment, but is not commonly related to antitubercular (anti-TB) agent, rifampin. PMC is frequently localized to rectum and sigmoid colon, which can be diagnosed with sigmoidoscopy. We report a case of rifampin-induced PMC with rectosigmoid sparing in a pulmonary tuberculosis patient. An 81-year-old man using anti-TB agents was admitted with a 30-day history of severe diarrhea and general weakness. On colonoscopy, nonspecific findings such as mucosal edema and erosion were found in sigmoid colon, whereas multiple yellowish plaques were confined to cecal mucosa only. Biopsy specimen of the cecum was compatible with PMC. Metronidazole was started orally, and the anti-TB medications excluding rifampin were readministerred. His symptoms remarkably improved within a few days without recurrence. Awareness of rectosigmoid sparing PMC in patients who develop diarrhea during anti-TB treatment should encourage early total colonoscopy.

Keyword

Enterocolitis, pseudomembranous; Antitubercular agent; Rifampin; Colonoscopy

MeSH Terms

Aged, 80 and over
Biopsy
Cecum
Colon, Sigmoid
Colonoscopy
Diarrhea
Edema
Enterocolitis, Pseudomembranous
Humans
Metronidazole
Mucous Membrane
Rectum
Recurrence
Rifampin
Sigmoidoscopy
Tuberculosis, Pulmonary
Metronidazole
Rifampin

Figure

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  Fig. 1 Endoscopic findings of the sigmoid colon showing edematous and erosive mucosa.

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  Fig. 2 Endoscopic findings of the cecum showing multiple elevated yellow plaques.

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  Fig. 3 Histological view of the cecal mucosa showing mushroom-shaped focal explosive lesions (H&E stain ×40).

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